With all the attention given to the slow pace of distribution of the swine flu vaccine, doctors and other providers are raising concerns about a shortage of vaccine for the other flu that is expected to slam the state and country this year.

Demand appears to be up for the seasonal flu vaccine, normally sought by about 30 percent of Marylanders. But doctors, retail outlets and clinics are running low or are out of doses.

Officials at the U.S. Centers for Disease Control and Prevention note that nearly all of the cases of flu now are of the swine flu variety, also known as H1N1, and there is still time to get a seasonal flu vaccination before an outbreak. Already, the six manufacturers of vaccine have shifted to production of H1N1 vaccine to deal with an expanding pandemic, and that has generated worry that the pipeline will run dry of seasonal flu vaccine before demand does.

"It's frustrating," said Dr. David Scharff, who runs an internal medicine practice on Conkling Street in Baltimore. "I haven't gotten any. For now, I'm telling my patients to try and get it elsewhere."

Scharff has a lot of middle-age and elderly patients - a target population for the seasonal flu vaccine but not for vaccine for the H1N1 virus, which isn't expected to hit that group hard. He ordered his 250 doses a bit late, he acknowledges, but supply hasn't been a problem since 2004, when there was a nationwide shortage.

Officials at the CDC reported Tuesday that they have heard again about shortages of seasonal flu vaccine. But they stress that more vaccine is coming. Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, said 77 million doses have been distributed. About 115 million total doses are expected.

The figure is lower than the 143 million to 146 million doses of seasonal flu vaccine ordered last year, though local authorities have said many of those doses went unused.

"We expect more doses in November," Schuchat said in a conference call with reporters. "The message I have is, be patient. We're seeing the H1N1 strain but we're not seeing the seasonal flu at all. We think there is still time. We think it'll be just fine to be vaccinated later."

The flu season generally lasts through the first few months of the year, and authorities say vaccinations are frequently given through January when seasonal flu usually peaks.

Providers are hoping the seasonal flu vaccine doesn't take that long to arrive. Columbia-based Maxim Health Systems offers vaccination clinics in retail and corporate settings and doctor's offices and has had to start a waiting list for its customers. Steve Pellito, the national director of wellness, said there is an overall increase in demand because of the publicity from the H1N1 outbreak and that demand is coming sooner in the season.

"We're absolutely seeing an increase in first-time immunizations," he said. "There is more demand. ... We know we're getting more vaccine, we just don't know how much more or when it will arrive."

CVS also reports that demand is "well ahead" of the demand a year ago for the seasonal flu vaccine in its 20 MinuteClinics around the state.

"We are working closely with multiple suppliers to meet this demand on a day-to-day basis," said Mike DeAngelis, a company spokesman. "When we experience isolated shortages of vaccine supply we do all we can to replenish these locations."

Unlike the H1N1 vaccine, which is being paid for and distributed by the federal government, providers are charged for supplies of seasonal flu vaccine that they order directly from manufacturers or distributors. That makes some doctors and providers even more anxious about their orders. Maybe no one will want them once they finally arrive, and that can mean the painful loss of thousands of dollars at small practices.

The makers say the supplies have been produced and are on the way. Novartis, for example, has said it had already completed its production of 27 million doses for the United States, which was earlier than the company has ever provided so much vaccine. The company has now switched its focus to producing H1N1 vaccine.

Gaithersburg-based MedImmune, which manufactures the nasal spray FluMist, produced 10 million doses of seasonal flu vaccine and has begun preparing 40 million more for the H1N1 flu, said Karen Lancaster, a company spokeswoman. Because of the lengthy and complicated process of making vaccine, she said it would not be possible to make more seasonal vaccine before the end of the flu season.

Last year, the company produced 7 million seasonal flu vaccine doses. The increase was ordered because this is the first full flu season in whichthe CDC has recommended all school children get vaccinated, and the nasal spray is now more widely used on children. Those as young as 2 can be given FluMist, which is a live vaccine.

"We provide vaccine to distributors and they fill orders," said Lancaster, noting the earlier demand. "We anticipate all the orders will be filled."

Indeed, some are getting supplies and are moving ahead with clinics. The Harford County Health Department announced Tuesday that it will hold a seasonal flu vaccination clinic from 10 a.m.-2 p.m. Friday at Fallston Middle School. Officials will administer the injectable vaccine in a "drive through" manner, so that recipients remain in their vehicles. The cost is free to Medicare recipients and $20 for all others.

Meanwhile, while the rest of the vaccine supply winds through the system, officials at the Maryland Department of Health and Mental Hygiene are working on the problems. They have been the gatekeeper for all of the H1N1 vaccine but have not been so directly involved in seasonal flu distribution.

For the seasonal flu vaccine, they have been doing a little horse-trading. Department spokesman David Paulson said officials have "tried to negotiate swaps and loans from those who have it and those who need it."

For more information on availability of the seasonal and H1N1 vaccines, go to flu.maryland.gov or consult your local health department.

By the numbers 77 million

Doses of seasonal flu vaccine have been distributed nationwide

114-115 million

Total number of doses expected this season.

143-146 million

Doses of seasonal flu vaccine that were slated to be produced last season.

250 million

Doses of H1N1 flu vaccine have been purchased by the federal government this year.